Early Results of a Novel Intramedullary Fixation Device for Proximal Fifth Metatarsal Fractures

CATEGORY: Midfoot/Forefoot; Sports; Trauma INTRODUCTION/PURPOSE: Proximal fifth metatarsal fractures are commonly treated surgically due to their poor healing capacity. While intramedullary screws may be the most popular operative treatment choice, newer fixation methods continue to develop that offer fracture compression in addition to maintenance of length, alignment and rotation. We present a case-series utilizing a novel intramedullary fixation device for proximal fifth metatarsal fractures. To our knowledge, no other study in the literature has assessed the safety and efficacy of this novel fixation method METHODS: A retrospective analysis was performed for 16 patients with proximal fifth metatarsal fractures who underwent fixation with the same novel intramedullary device. Patient charts were reviewed for fracture union, plantar fracture gapping, time to weightbearing, refracture, perioperative complications, and secondary surgeries. RESULTS: Sixteen patients with an average age of 43.3 years old underwent fixation with this novel device from 2015 to 2020. Mean follow-up was 32.4 weeks. Fifteen of the 16 patients achieved radiographic union at a mean of 8.9 weeks. One patient suffered a non-union. Mean time to full weight-bearing in, and out of, a walking boot was 6.4 and 9.8 weeks, respectively, for healed fractures. Mean plantar fracture gap improved from 1.22 mm to 0.88 mm following surgery. There were zero infections, refractures or hardware complications. Three patients suffered iatrogenic distal diaphyseal fracture during implant insertion, however postoperative progression to weightbearing was not altered in these patients relative to the remainder of the cohort. CONCLUSION: To our knowledge, this is the first report of early results for this novel intramedullary device. Excellent union rates, acceptable time to weight bearing, and a low complication profile can be achieved. Additionally, plantar fracture gapping, which has been shown to delay time to union, was improved using this novel implant. Based on our early findings, we propose a viable treatment option that is safe and effective for proximal fifth metatarsal fracture stabilization.